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The Kaiser Family Foundation policy research on medicaid expansion and the implementation of the current healthcare reform is very optimistic and useful. However, it would be prudent to look at the local healthcare infrastructure’s ability to both create (healthcare outreach) and meet the new demand for the coverage that the healthcare act promises. Indeed, a decade of the most draconian recession in recent history has not helped the public health sector to recruit and diversify its workforce in order to be ready to take on the potential numbers of Latinos, for example, who would benefit disproportionately from the new access as they are over represented in the labor and business sectors that currently provide jobs without health benefits. According to the Kaiser Family Foundation, the healthcare reform picture is quite rosy, but for Latinos healthcare reform may not be quite the rose garden envisioned by current mainstream health policy pundits. The Policy ThinkShop

According to the Kaiser Foundation:

“A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in evaluating the ACA Medicaid expansion are:

1. What are the fiscal implications of the ACA Medicaid expansion for states?

Overall, many states are likely to see net savings from the Medicaid expansion.

The Medicaid expansion also may have positive economic effects for states like increased jobs, revenues or economic activity.

Studies show that the Medicaid expansion could increase revenues to hospitals, offsetting hospital reimbursement reductions that were also included in the ACA.

Some states are concerned about federal deficit reduction efforts and the implications for Medicaid; however, the FMAP formula that determines the federal share of Medicaid spending has remained steady since the start of the program. Congress has only amended the formula to provide more federal funding, not less.

2. What effect will the Medicaid expansion have on coverage?

The Medicaid expansion would make health care coverage available to millions of low-income adults and significantly reduce the number of uninsured.

A large body of research shows that Medicaid increases access to care and limits out-of-pocket burdens for low-income people. Despite claims to the contrary, research points to improved outcomes and reduced mortality from Medicaid coverage.

Actions to address workforce challenges and low provider participation in Medicaid will be important to improve access with the Medicaid expansion.

For most states that do not implement the ACA Medicaid expansion, there will be large gaps in coverage for low-income individuals because individuals with incomes below poverty are not able to access subsidies to purchase coverage in in the new health insurance exchanges.

3. What flexibilities do states have in implementing the Medicaid expansion?

States have considerable flexibility to administer traditional Medicaid programs.

Under the ACA Medicaid expansion, states have flexibility around benefits, cost sharing as well as how to deliver and pay for care.

Proposals are emerging that would allow states to purchase exchange coverage for Medicaid expansion enrollees through premium assistance options.

States also continue to have ability to seek approval for demonstration waivers. Beginning in 2017, 1115 waivers may be combined with State Innovation Waivers.”

After years of the seemingly inadvertent fomentation of distrust among its polity (the growing role of the U.S. government and the Vietnam war, for example), technology has opened up a potentially ubiquitous eavesdropping by the federal government that is eerily reminiscent of George Orwell’s 1984. It does not seem sinister, though, since it thus far appears to be the outcome of an aggressive privatization policy that was probably compelled by the rapid implementation of our most recent wars. Nevertheless, Americans have the right to ask question, remain vigilant and demand answers if not reform.

“A majority of Americans – 56% – say that federal courts fail to provide adequate limits on the telephone and internet data the government is collecting as part of its anti-terrorism efforts. An even larger percentage (70%) believes that the government uses this data for purposes other than investigating terrorism.

And despite the insistence by the president and other senior officials that only “metadata,” such as phone numbers and email addresses, is being collected, 63% think the government is also gathering information about the content of communications – with 27% believing the government has listened to or read their phone calls and emails.”

It is dumbfounding! It paralyzes the brain, the heart and almost all hope–without need for audacity.

Ph.D.s, advocates, health professionals, and good old moms and dads come to the agreement that healthcare needs changing and that sick people should get help–especially those who have difficulty getting it. Presumably, it is logical and reasonable to think that many of these people are what we, all of us for hundreds of years, have called “the poor.”

Yet for as long as there have been those with and those without, those with often have the efficacy to get more and those without, perhaps by definition, get even less–always…

So here we are well into healthcare reform and the NYT is sounding the whistle on the haves once again–millions have been spent and the poor are somehow invisible once again when it comes to targeting the needs of those who are hurting and are having a difficult time getting good, reliable, continuos, patient centered, medical home care! Go figure… or better yet, go read the New York times…

“The refusal by about half the states to expand Medicaid will leave millions of poor people ineligible for government-subsidized health insurance under President Obama’s health care law even as many others with higher incomes receive federal subsidies to …”

The Pew Foundation’s research arm did a nice job on a survey on “the State of the State of the Union Address.” It appears that President Obama is riding a tremendous popularity and approval wave into a second term that is already characterized by a buoyed economy with clear skies ahead. The President’s victory on the fiscal cliff seems to have sealed the deal, as the President enters his second term with the Republicans in shambles and, perhaps more importantly, with Americans believing in this two term President the opposition tried to paint as a boogyman. The President seems to be smiling on, like the baby boomer that he is, saying: “Boogie oogie oogie!”

“President Barack Obama delivered his State of the Union address to the nation on Tues., Feb. 12. A survey released ahead of his speech found that 43% of the public views the president’s address as about as important as past years’ addresses, and a third (32%) say Obama’s speech will be more important than those in past years.

Here’s a roundup of Pew Research findings across 10 of the biggest public policy issues:

The Economy

The economy and jobs remain the public’s top two priorities for the White House and Congress.

57% of Americans (and 74% of Republicans) say that President Obama won the battle over the “fiscal cliff.”

Americans took a dim view of the fiscal cliff deal, saying it would hurt: the economy (46%), people like themselves (52%), efforts to curb the deficit (44%).

Read more about Pew Research findings on the economy

Debt and Deficit

72% of Americans now say reducing the deficit is a top priority, up from 53% in Jan. 2009, including 84% of Republicans, 67% of Democrats and 71% of independents.

There are wide partisan gaps on many debt reduction proposals, including reducing military defense spending (+35 points Democrats) and reducing funding to help low-income people (+29 points Republicans).

74% say a combination of program cuts and tax increases is the best way to reduce the deficit.

Read more about Pew Research findings on the debt and deficit

The Middle Class

The median income for a middle-income, three-person household fell to $69,487 in 2010 from $72,956 in 2000 (in 2011 dollars.) Median net worth among the middle-income tier fell 28% to $93,150 in 2010 from $129,582 in 2000.

85% of those in the middle class say it is more difficult today than a decade ago to maintain their standard of living.

There is broad public support for background checks for private and gun show sales (85%) and laws preventing the mentally ill from purchasing guns (80%).

There are large partisan divides on creating a federal database to track gun sales (35-point gap, Democrats favor), implementing a ban on assault-style weapons (25-point gap, Democrats favor) or having more teachers and school officials with guns in schools (33-point gap, Republicans favor).

Read more about Pew Research findings on gun control

U.S. Foreign Policy

83% of Americans say that “we should pay less attention to problems overseas and concentrate on problems here at home,” up 10 points since 2002.

40% say the U.S. relies on military strength too much to achieve its foreign policy goals, 44% say about the right amount and 10% say too little.

63% say the U.S. should be less involved in Middle East leadership changes.

Americans largely approve of the use of drones to target extremists, unlike most other nations surveyed.

71% say defending the nation from terrorism is a top priority.

60% support withdrawing troops from Afghanistan “as soon as possible.”

The Patient Protection and Affordable Care Act promises to change our healthcare system once and for all to solve many of its ongoing malformations and contradictions … No where is this more true than in its expansion of healthcare services to persons under the Medicaid umbrella. The Kaiser Foundation web, which always provides data and balanced analysis on the usually controversial health issue and so called “entitlement programs” like Medicaid. The link below includes an entire report showing estimated impact on each of the 50 states …

“A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population.

This analysis uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to provide national as well as state-by-state estimates of the impact of ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured. This analysis shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured. Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and some states are likely to see small net budget savings.”

Increasingly, philanthropists and philanthropic institutions are becoming more strategic in their efforts, working to leverage their assets – money, knowledge and networks – to achieve greater results. The Center studies the structures and networks that enable philanthropy to work better together to extend its impact as a field, and the alliances that enable philanthropic organizations and individuals to work with partners in nonprofits, government and business to solve public problems. The Center’s Distinguished Speakers Series also provides a venue for nationally recognized leaders to stimulate a conversation on the role that philanthropy can and should play in public problem solving.

In general, more Americans say that government regulation of business is harmful than say it is necessary to protect the public. At the same time, when asked about regulating specific areas, such as food safety and environmental protection, there is broad support for strengthening or maintaining current regulations.

Just over half (52%) of people say government regulation of business usually does more harm than good, while 40% think regulating business is necessary to protect the public interest. These results, from a survey conducted Feb. 8-12, are similar to those from January 2008, before the financial crisis and onset of the economic recession.

RONALD REAGAN appointed him to a federal judgeship. He served as acting attorney-general under George Bush junior. He has backed a law allowing investigators to interrogate terrorism suspects without informing them of their rights. As a federal attorney he prosecuted two prominent Democratic congressman; in private practice he represented large corporations. This is the CV not of a Republican judicial candidate, but of Eric Holder, Barack Obama’s attorney-general. Long unpopular with the right as well as the left, Mr Holder may well spend the coming year …

Nearly two-thirds of Hispanics in the United States self-identify as being of Mexican origin. Nine of the other ten largest Hispanic origin groups—Puerto Rican, Cuban, Salvadoran, Dominican, Guatemalan, Colombian, Honduran, Ecuadorian and Peruvian—account for about a quarter of the …

By a ratio of more than two-to-one (59% versus 27%), Latinos disapprove of the way the Obama administration is handling deportations of unauthorized immigrants, according to a new national survey of Latino adults by the Pew Hispanic Center, a project of the Pew Research Center.

Deportations have reached record levels under President Obama, rising to an annual average of nearly 400,0001 since 2009, about 30% higher than the annual average during the second term of the Bush administration and about double the annual average during George W. Bush’s first term.

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